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Community-wide vaccination, the single most effective way to prevent measles – MRI Virologist

Follow the National Immunisation schedule and protect your child

by damith
September 24, 2023 1:12 am 0 comment 566 views

By Carol Aloysius

Following the red alert by the Epidemiology Unit of a measles outbreak in Sri Lanka and an urgent appeal by the Ministry of Health for parents of all children with missed doses to immediately get in touch with their MOH and complete their doses , the Sunday Observer spoke to Consultant Medical Virologist and Head of the Department of Virology, Medical Research Institute (MRI) Dr. Janaki Abeynayake, to get more insights into how this highly contagious virus spreads and what precautions should be taken to prevent risks of being affected by the current Measles outbreak.

Excerpts.

Dr. Janaki Abeynayake

Dr. Janaki Abeynayake

Q: The Epidemiology Unit recently warned that Sri Lanka is currently experiencing a measles outbreak with several cases being reported from various parts of the country. My question is wasn’t Sri Lanka declared as a Measles free country by the UN and WHO just a few years ago? So how did this new outbreak occur?

A. Yes, Sri Lanka has been declared as a Measles free country since 2019 by the WHO. However, any person who is unvaccinated, incompletely vaccinated (single dose) or has no history of measles infection is non-immune to measles and is at highest risk of acquiring the infection following an exposure to a known measles case or recent travel to areas with active measles transmission. This fact encourages the virus to circulate leading to outbreak as measles virus has the uncanny ability to spot these immunity gaps.

Q: When did it start? How many cases have been reported since then?

A. The 1st case of an adolescent resident from Colombo, was reported in May 2023 and we are experiencing a gradual increase in the number of cases up to date. Our present data indicates that all provinces have reported cases by now.

Q: Is it true that Measles transmission is more in highly populated areas than in less densely populated areas?

A. Yes, overcrowding in residential areas such as slum areas increases the risk of transmission of the measles virus. Measles also has a greater risk of transmission in poor hygienic environments because contaminated hands with respiratory secretions facilitate the virus transmission.

Q: Age-wise and gender-wise who are most likely to be affected by the fresh outbreak of this highly contagious disease?

A. It can affect susceptible people of any age though it is regarded as a childhood disease. Since the introduction of the childhood vaccination programme, the pattern of disease has changed. Although measles used to be a childhood illness, it is now seen among young adults and the elderly who are not immune to the infection. At the moment the children we are detecting of having measles are mostly unvaccinated or incompletely vaccinated.

Q: How does the virus enter the human body ? Is it airborne?

A. Yes, it is airborne and generally considered the most infectious virus known to mankind. An infected person can spread the virus to 9-18 susceptible people by coughing or sneezing. A person can acquire the virus by touching an infected surface and then subsequently touching their eyes, nose, or mouth, they can become infected.

Q: What are the initial signs/symptoms to look out for when a person gets infected?

A. Early symptoms include fever, running nose, cough, red and watery eyes. Also, in some cases, small bluish-white spots can be seen inside the cheeks. There is a characteristic rash starting from the face and spreading to the rest of the body.

Q: How long does it take for these clinical features to present themselves? Immediately or does it develop after some days or weeks?

A. It varies. Usually, the symptoms of measles begin 10–14 days after exposure to the virus.

Q: Can they be mistaken for other infectious diseases like chickenpox which also causes skin rashes , accompanied by high fever etc?

A. Yes, it sometimes can be mistaken as chickenpox. However, with chickenpox, you get a lot of fluid-filled vesicles/blisters. Whereas in measles the rash develops as tiny red patches, some of which are flat and some elevated. The measles rash is more similar to a sweat rash. Also, the fluid-filled blistering appearance is not seen.

Q: Do symptoms vary according to the age and health status of the person? If so, what are the differences?

A. Generally the symptoms are similar across different ages but those with weakened immune systems like those on chemotherapy or having HIV may not present with the rash. Children below 5 years, adults over 30 years, and those who are malnourished or immunosuppressed are more likely to have severe symptoms and complications. Measles itself also weakens the immune system leaving children extremely vulnerable.

Q: Can good nutrition, healthy diets and vitamins help to prevent/ minimise the effects of measles in children and reduce complications?

A. Yes. Nutrition, a healthy diet and vitamins play a big role in preventing severe infection. Especially in Measles, the infected children are given vitamin A high doses which act as an immunomodulator that boosts the antibody response to measles and prevents severe complications including blindness.

Q: If untreated, can the disease progress? If so, what are the stages?

A. There are four stages of illness: incubation, prodrome, rash and convalescence. This is the natural progression of infection. There is no specific antiviral treatment and even without treatment, people will recover. However, those who develop complications would recover better with supportive treatment.

Q: What are the complications when it reaches the most severe stage?

A. Complications can include blindness, encephalitis (an infection causing brain swelling and potentially brain damage), severe diarrhoea and related dehydration, ear infections, and severe breathing problems including pneumonia. If a pregnant mother catches measles during pregnancy, there is a risk for the mother which can result in her baby being born prematurely with a low birth weight.

Q: Can one die of measles if untreated?

A. Yes. This is important to emphasise. Those with complications can die which is the reason why prevention of infection is so important. Malnourished children or those with weakened immune systems are at the highest risk of death from measles. Otherwise the death rate is very low among normal individuals.

Q: How are persons who already have measles usually treated in a hospital? Is there a specific treatment? Walk us through the procedure.

A. There is no specific treatment for Measles. Infected patients are provided with supportive care focusing on relieving symptoms, making the person comfortable and preventing complications. This includes good hydration with adequate fluids, medication for fever, vitamin A to reduce the risks of complications and pain relief. Some groups like young children, severely malnourished individuals, pregnant mothers and people with weak immune systems are provided with more attention as they have a higher risk of complications.

Q: If treated in time will a patient with measles recover completely?

A. Many viral infections, including Measles have the tendency to recover by good immune response in normal healthy individuals. Additionally, timely administered supportive care may improve the outcome.

Q: Can a person who has been treated for measles get another attack if exposed to an infected patient? What are the chances?

A. No, usually not. Following the natural infection, you get lifelong immunity and the possibility of getting a second attack is very rare.

Q: Is hospitalisation essential for treating measles?

A. No, it depends. Only those with severe symptoms or at risk of complications need hospitalisation, especially immunocompromised individuals.

Q: Is the treatment the same for all?

A. The management is generally tailored to patients according to their symptoms and examination findings. Children are given special attention with greater attention to good nutritious food and additional supportive care. Antibiotics should be prescribed if secondary bacterial infections such as ear infections or pneumonia occur. Vitamin A supplementation is also recommended for children.

Q: So how can one protect themselves from this disease? Is there a vaccine? If so, where is it available?

A. There is a Measles Mumps Rubella (MMR) vaccine which is able to protect against measles along with rubella and mumps. It is administered as part of the national immunisation program for all children in Sri Lanka. It is generally administered from the MOH and is available in the private sector as well.

Q: Who is responsible for administering the vaccine? Officers from the Epidemiology Unit or public health workers?

A. Public Health Officers in MOH, are involved in administration. Additionally there are vaccine clinics in some hospitals or general practitioners in the private sector can administer the vaccine as well. However, it is the responsibility of the parents to take their child to be vaccinated.

Q: How often and at what age is the vaccine given? Is there a change in the National schedule due to the current outbreak?

A. Two doses of the MMR vaccine are given to children. The first dose is usually given at the completion of 9 months and the second dose is given at the completion of 3 years for all children. At the moment there is no change to the national vaccine schedule but the problem in the current outbreak is not in the timing but children not being given the vaccine. Therefore, what is being promoted is for all those who had missed the vaccine to urgently get the missed dose from their MOH according to the guidelines we have issued.

Q: In your capacity as Consultant Medical Virologist & Head of the Department of Virology of the Medical Research Institute ( MRI) tell us what role the MRI plays regarding detecting and identifying the measles virus ?

A. We have prepared guidelines and shared them across the country for sample collection and sending out the samples. We make sure the testing facility is available to the genomic sequencing level without any interruption and carry out early testing and accurate reporting of results with a minimum turnaround time for appropriate national action. In addition, as a partner of the global measles elimination program we need to share the country’s measles surveillance data on a global platform accordingly while meeting the timelines of the global program.

Q: Facilitating transport of samples from far away districts to the MRI for examination could be a daunting task. How are you able to do this without exposing such samples to contaminating them in transit?

A. We have a well-established system to transport samples from any part of the country. Sample send out guidelines are prepared by the MRI and distributed across the country to be followed to ensure prevention of exposure of individuals during transportation. So, we are seeing that samples we receive are in good condition at our National Reference Laboratory. There is minimal risk of contamination of samples as they are well packed in appropriate containers and transported in authorised vehicles.

Q: Do you have a message to the public on preventing , treating and reducing risks from the current measles outbreak?

A. Community-wide vaccination is the single most effective way to prevent measles. All children should be vaccinated against measles according to the national immunisation schedule. If there is any child with missed vaccine doses, parents should meet their Medical Officer of Health (MOH) and arrange the vaccination immediately.

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